9/13 - Resistance Exercise for Impaired Muscle Performance Flashcards
strength
ability of contractile tissue to produce tension
power
work produced by ms over time
(f x d/t)
endurance
ability to perform low intensity, sustained activity over a prolonged time
overload principle
progressive loading (strength)
progressive reps (endurance)
SAID principle
Specific Adaptation to Imposed Demands
- exercise prescribed specific to function
- what is the deficit and how do we address this
transfer of training
carryover of effects from one type of exercise to another
- ex: strength program also improve endurance
only limited evidence, greater support for specificity of training
reversibility principle / detraining
if you don’t use it you lose it
- detraining can happen more rapidly than building up the muscle
what influences the amt of tension able to be generated
energy stores and blood supply
fatigue
recovery from exercise
muscle (local) fatigue
diminished response of muscle
CP (general) fatigue
diminished response of person
threshold for fatigue
level of sustainable activity
what are other factors which influence fatigue
overall health
diet
sleep
what are general factors of fatigue that can impact the possible tension to be generated
muscle/local fatigue
CP/general fatigue
threshold of fatigue
other factors
how does age impact tension generation in normal skeletal muscle
childhood - linear inc in strength to puberty
adolescence - strength levels significantly differ b/w sexes
adulthood - women reach peak strength at younger age than men
late adulthood - decline of 15% or greater each year >60yo
what are psychological and cognitive factors which influence tension generation
attention
motivation
feedback
where do you see physiological adaptations to resistance exercise
neural adaptations
skeletal muscle adaptations
vascular & metabolic adaptations
adaptations of connective tissues
what neural adaptations are seen to resistance exercise
inc EMG without hypertrophy
- motor learning & improved coordination
what skeletal muscle adaptations are seen to resistance exercise
hypertrophy - inc size of ms fiber
- inc protein (actin & myosin) synthesis
hyperplasia - inc number of ms fibers
- limited evidence
muscle fiber type adaptation
- IIB converted to IIA
what vascular and metabolic adaptations are seen to resistance exercise
muscle hypertrophy
- dec capillary bed density as myofilaments inc
what adaptations of connective tissues are seen to resistance exercise
tendons, ligaments, connective tissue in ms
- tendon/ligament tensile strength inc w resistance training
bone
- ms strength correlated w bone density
how is alignment different from stabilization
alignment of muscle fibers
- changes the primary mover
alignment of gravity
stabilization in that position
describe how the position of the hip affects the alignment of the muscle fibers
if flexed»_space; more TFL
if extended»_space; more glut med
how can intensity vary and what determines this
submaximal vs maximal exercise loads
- considered desired goal of program
what about the initial level of resistance (load) should be documented to assess training effects
repetition maximum
- provides baseline to measure progress
- trial & error
training zone
- % of RM
- initially low for untrained patients
what components of volume are determinants of resistance exercise
reps and sets
- consider goals of exercise activity & individual patient
describe the impact of exercise load and reps on desired muscles
improve ms strength = high load/low reps
improve ms endurance = low load/high reps
what does the exercise order have an impact on
fatigue
- large ms groups before small
- multi-joint exercises before single joint
what should be considered when prescribing frequency of exercise
inc intensity and volume = inc recovery time
what program duration is needed for neural adaptations
2-3 weeks
what program duration is needed for hypertrophy
6-12weeks
what are components for the mode of exercise that should be considered (6)
type of ms contraction
position for exercise
forms of resistance
energy systems
range of movement
patient & outcome specific
what types of ms contractions are considered for the mode of exercise
concentric
eccentric
isometric
what about the position for exercise should be considered for mode of exercise
WB
non- WB
what about forms of resistance should be considered for the mode of exercise
manual
mechanical
body weight
what about energy systems should be considered for the mode of exercise
aerobic
anaerobic
what about range of motion could be considered for mode of exercise
short arc
full arc
what about the velocity of exercise is important for determining resistance exercise
function specific
force-velocity relationship
- concentric
- eccentric
what is periodization
variability of training for specific goal
how can you integrate function into an exercise program
balance of stability and active mobility
balance of strength, power, endurance
task specific movement patterns during resistance exercise
what are 6 types of resistance exercise
manual and mechanical
isometric
dynamic - concentric/eccentric
dynamic - constant / variable
isokinetic
open chain / closed chain
what is manual resistance exercise and what are the pros of this
provided by therapist
gives you real time feedback
can feel when start to fatigue
can adjust amt of force
- more in mid range, less in end range
what is mechanical resistance exercise
provided by equipment
what is the rationale for using isometric exercise
stability
what are types of isometric exercise (3)
muscle setting exercises
stabilization exercises
multiple angle isometrics
what is an example of a muscle setting isometric exercise
quad set
what is an example of a stabilization isometric exercise
PNF alternating isometrics
what is an example of multiple angle isometrics
4-6 points in ROM
- PNF, engage ms at different angles
what is another word for isometric in terms of exercise
static
intensity of isometric training
60% of MVC
duration of muscle activation
6-10sec
why does isometric training have repetitive contractions
dec cramping
isometric training joint angle and mode specificity
individualized to activity
rationale for using concentric vs eccentric exercise
concentric - accelerate
eccentric - decelerate
exercise load and concentric vs eccentric
inc loads are better controlled w eccentric
energy expenditure with concentric vs eccentric exercise
eccentric more efficient
mode specificity w concentric vs eccentric exercise
eccentric more mode specific than concentric
what is the cross-training effect with concentric and eccentric exercise
opposite side (L vs R) may be stabilizing
exercise-induced ms soreness with concentric vs eccentric exercise
inc DOMS w eccentric
- (delayed onset muscle soreness)
constant vs variable resistance w dynamic exercise
dynamic constant external resistance exercise (DCER)
- max challenge occurs at only one point of ROM
variable-resistance exercise
- challenges ms throughout ROM
- cybex equip and/or tubing
what are special considerations for DCER and variable resistance exercise
arc of motion by patient
controlled pace
where are isokinetic machines typically seen
more research than clinical practice
what is the role of velocity in isokinetic training
constant velocity of ms shortening / lengthening
what is the range and selection of isokinetic training velocities
0-500 degrees / sec
how can muscle groups be activated in isokinetic exercises
reciprocal movements with isolated muscles activated
how is isokinetic exercise specified
velocity specific
what is the role of compressive forces on joints and isokinetic exercise
dec at a faster velocity
how does isokinetic training accommodate for fatigue and/or a painful arc
dec the force = dec resistance
isokinetic training effects and carryover to function
there is limited carryover to function
- single ms or segment is isolated
what are special considerations for isokinetic training
availability of equipment
appropriate setup
open chain exercise
distal segment moves
independent joint movement; unpredictable pattern
segments moving are distal to moving joint
typically NWB
ex: sitting and ext knee
closed chain exercise
distal segment stationary
interdependent joint movements
predictable patterns
distal & proximal segments moving
typically WBing
ex: standing and squats
OKC or CKC: isolation of ms groups
OKC
OKC or CKC: control of movements
OKC
OKC or CKC: joint approximation
OKC & CKC
OKC or CKC: more functional
CKC
OKC or CKC: co-activation and dynamic stabilization
CKC ?
OKC or CKC: proprioception, kinesthesia, NM control, and balance
CKC
OKC or CKC: carry over to function and injury prevention
OKC and CKC
how can you progress closed chain exercises (7)
% body weight (partial -> full)
BOS (wide -> narrow)
support surface (stable -> unstable)
balance
- (+) support -> (-) support
- EO -> EC
limb movement (short -> full arc)
plane of movement (uni-> multiplanar)
speed of movement (slow -> fast)
why is placement of resistance important
dictates how challenging it is
when is direction of resistance important
manual load
- careful of hand placement bc can impact how they activate their ms
why do you stabilize w resistance exercises
prevent substitution
how do you decide if verbal or written instructions are best for the patient
depends on their learning style
what is a val salva maneuver
expiration w closed glottis
what can the valsalva maneuver cause in at risk patients
inc BP
how do you prevent valsalva maneuver during resistance exercise
avoid holding breath
exhale on lift
what are precautions for resistance exercise
valsalva maneuver
substitute motions
overtraining and overwork
exercise-induced ms soreness
pathological fx
what can encourage substitute motions which should be avoided
applying too much resistance
overtraining vs overwork
overtraining - decline in performance
overwork - decline in strength
what does overtraining and overwork put the patient at inc risk for
injury
types of exercise induced muscle soreness
acute ms soreness
delayed onset ms soreness (DOMS)
acute ms soreness
during or directly after exercise
delayed onset ms soreness (DOMS)
12-24hrs post exercise
how to prevent DOMS
gradual progression
warm up / cool down
what patients are at inc risk for a pathological fx
osteoporosis
osteopenia
what are contraindications to resistance exercise
pain
inflammation
severe CP dz
appropriate exercise for a patient in pain
AROM w/o resistance
appropriate exercise for patient w inflammation
isometric exercise
appropriate exercise for patient w severe CP dz
assess parameters of activity & impact on cardiac / respiratory systems
what are 4 advantages of manual resistance exercise
- resistance adjusted throughout ROM
- ms works max throughout ROM bc resistance is adjusted
- control ROM to protect healing tissues
- can minimize how hard they are working in certain areas - manual stabilization prevents substitution
what are 3 disadvantages for manual resistance exercise
- resistance is subjective
- patient can’t perform independently
- labor and time intensive for PT
resistance training guidelines for healthy adults (<50-60yo) — (8)
- begin w warmup followed by flexibility
- perform thru full, pain free ROM
- balance flex / ext exercises
- utilize concentric / eccentric
- mod intensity (60-80% 1RM)
- rhythmic controlled motions
- maintain normal breathing
- cool down after exercise
resistance training guidelines for children
no formal resistance training under 6yo
- focus on play and body weight activity
wt training introduced in pre-pubescent years
wt training guidelines in pre-pubescent years (5)
- close supervision w attention to proper form
- low loads & intensity
- limit frequency to 2x/wk
- caution w eccentric exercise
- ensure equipment is appropriate for child’s size
what do you need to do resistance training in older adults (>60-65yo)
MD clearance
what should be avoided with regards to resistance training in older adults & why
high load resistance
- tissues potentially more susceptible to overloading
flexion dominant exercise that could create postural dysfunction
- more ext bias»_space; tend to be tight and weak
what are 4 other guidelines for resistance training in older adults
begin w 5-10min of warm up
monitor vital signs
40-60% 1RM intensity
48hr rest interval b/w sessions
what role does an individualized prescription play a role in
better outcomes and engagement
what specific demands of the patient should be considered
ADL
work
sport
goals
